Flashcards in Chronic Kidney Disease Deck (12)
Describe the standard classification of CKD.
HINT: there are 5 stages, but one of them has 2 subcategories!
Stage 1: GFR 90+
Stage 2: GFR 60-89
Stage 3: GFR 30-59
Stage 4: GFR 15-29
Stage 5: GFR <15 OR on dialysis
Describe additional classification of CKD, based on proteinuria. (3)
A1 - none
A2 - mild proteinuria
A3 - heavy proteinuria
List 2 complications of CKD.
Abnormal calcium/phosphate metabolism
Describe the abnormal calcium/phosphate metabolism in CKD. (5)
1. Phosphate levels INCREASE (bc not peed out), and calcium levels DECREASE (bc not reabsorbed)
2. Increased phosphate/decreased calcium stimulates PTH
3. PTH causes increased bone resorption to increase calcium levels
a. BUT this also removes phosphate from bones
b. Therefore calcium levels CORRECTED, but phosphate INCREASES FURTHER
4. Kidneys can't work despite PTH, therefore even more PTH stimulated
a. Positive feedback loop created
5. High levels of calcium and phosphate recombine in the arteries
a. This causes calcification of arteries
How would you manage CKD? (9)
HINT: these management options are split into 3 groups.
Reduce proteinuria, e.g.
Adjust drug doses
Correct abnormal calcium/hosphate metabolism
TREAT END STAGE RENAL FAILURE:
What is the target BP in CKD?
Which drugs would you use to achieve this? (3)
Which drugs would you use to reduce proteinuria? (2)
How do ACE inhibitors/ARBs reduce proteinuria? (3)
Reduction of systemic BP
Relaxation of efferent arteriole, therefore decreased intraglomerular pressure
Gradual reduction in glomerular protein permeability
Apart from giving drugs, how would you treat hyperkalaemia? (3)
Restrict diet, e.g.
Stop relevant drugs, e.g.
-Potassium sparing diuretics
How would you prevent abnormalities in calcium/phosphate metabolism? (2)
Phosphate binder (with meals)
Alfacalcidol (vitamin D)
How would you treat abnormalities in calcium/phosphate metabolism? (2)
Cinacalcet (blocks Ca2+ receptor on parathyroid gland)